Bipolar Flashcards
difference between mania and hypomania?
mania= 7 days and impact on functioning
hypomania= 4 days and dont impact on functioning
what is bipolar 1?
-one episode of mania
what is bipolar 2?
-depression with episode of hypomania
what is mixed affective state?
-features of mania with depressive symptoms (suicide risk)
long term management of mania?
> 6 months of treatment with mood stabiliser
1st line= lithium
2nd (if not responding) = sodium valproate or carbamazepine in women of child bearing age
what monitoring is done for people on lithium and why?
It has a narrow therapeutic window so must monitor plasma levels to avoid toxic symptoms
toxic symptoms= vomiting, diarrhoea, ataxia, reduced GCS, convulsions
SE lithium in pregnancy?
Ebsteins anomaly
-congenital heart defect in which the tricuspid valve is incorrectly formed and positioned lower than usual in the heart
what can occur if lithium is withdrawn too quickly?
rebound mania
SE of lithium?
-narrow therapeutic window so can cause toxic symptoms (vomiting, diarrhoea, ataxia, reduced GCS, convulsions)
-hypothyroidism, dry mouth, tremor, metallic taste, fatigue, polyuria, renal damage, weight gain
-Rebound mania if withdrawn too quickly
-Ebsteins anomaly if taken when pregnant
acute management of mania?
1st line= antipsychotic + benzodiazepine
2nd= ECT
STOP ANTIDEPRESSANTS!!
If on antimanic meds: optimise dose and add anticonvulsant/ antipsychotic
where is lithium excreted?
via the kidneys
lithium is indistinguishable from sodium- why is this a problem?
in dehydrated states there is increased sodium uptake which thus increases levels of lithium, this then causes further D+V which causes further dehydration which repeats the cycle
